Abstract

Background Although perimenstrual asthma (PMA) has been documented in up to 40% of asthmatic women and is often associated with severe and unstable course of the disease, studies on PMA are still inconsistent.

Objectives To compare levels of bronchial hyperactivity (BHR) to metacholine between premenopausal PMA and non-PMA asthmatic women in relation to sputum concentration of proinflammatory cytokines.

Methods Premenopausal women with regular menstrual exacerbations diagnosed as: PMA (n= 12), non-PMA asthmatics (n=9), and healthy controls (n=10) were prospectively followed over 2 consecutive menstrual cycles. Prior to study airway responsiveness to methacholine was performed in each subject. Total IgE blood concentrations as well, as sputum induction were determined in the 10th and 26th day of each of the two cycles. Sputum concentration of: eotaxin, IL-1β, IL-4, IL-10 were measured by ELISA.

Results Levels of BHR to metacholine as well, as total blood IgE concentrations in PMA subjects were significantly higher than in non-PMA asthmatics and healthy controls (p=0.001, p=0.02 respectively) and correlated with each other (p=0.04, r=0.86). Sputum eotaxin and IL-4 concentrations in both, luteal and follicular phase were increased in PMA patients when compared with non-PMA asthmatics (p=0.02, p=0.04, respectively). No differences as far as sputum levels of IL-10 between groups were noticed.

Conclusions BHR level in PMA is higher than in non-PMA asthmatics and correlates with increased total IgE concentration. The increased level of BHR in PMA patients is associated with a shift in the type-1/type-2 cytokine balance toward a type-2 response.